Abstract Body (Do not enter title and authors here): Background:
Regular walking is associated with improvements in physical function and quality of life among adults with peripheral artery disease (PAD). Neighborhood characteristics can influence walking behaviors; however, data on neighborhood walkability among adults with PAD are scarce.

Hypothesis:
We hypothesized that neighborhood walkability is associated with maximal and pain-free walking distance.

Methods:
Baseline data from the Physical Activity Daily Study were used for the present analysis. Participants were excluded if missing data on neighborhood walkability, walking distance, or quality of life measures. Neighborhood walkability was measured using the Neighborhood Environment Walkability Scale (NEWS). Maximal and pain-free walking distances were measured using the Gardner Protocol, and six-minute walk distance (6MWD) was measured using the American Thoracic Society protocol. QOL was measured using the Peripheral Artery Questionnaire (PAQ). NEWS item and domain means were compared across tertiles of resting ABI and of each PAQ summary and domain score using one-way ANOVA.

Results:
A total of 168 participants (69% male) were included in the present study. Mean ankle-brachial index (ABI) was 0.63 (standard deviation [SD] 0.19). Mean maximal and pain-free walking distances in feet were 1,351.46ft (1,146.15 SD) and 709.02ft (803.69 SD), respectively. Mean 6MWD was 1,023.81ft (416.28 SD). Participants with lower ABIs were more likely to report major barriers to walking in their local area on the NEWS survey (p<0.01). The PAQ summary score was also lower among participants who reported major barriers to walking in their local area on the NEWS survey (p<0.01). Participants who reported concerns for crime in their neighborhood were more likely to have a lower PAQ scores for several domains, including QOL domain (p<0.01), physical function (p<0.01), symptom stability (p = 0.05), and symptom severity (p = 0.01). Participants with lower scores for the symptom stability domain were more likely to report having fewer places to walk (p=0.02),

Conclusion:
These data suggest neighborhood characteristics are associated with PAD QOL, including symptom severity, symptom stability, and resting ABIs. Understanding neighborhood environments can inform the development of walking interventions for adults with PAD.